Active NPI
Kelly A Jackson, DC
- Chiropractor
- Natick, MA
National Provider Identifier
1104986793
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 1797
- Practice address
- 190 North Main Street
Natick, MA 01760 - Phone
- (508) 651-2646
- Fax
- (508) 655-6650
- NPI assigned
- Dec 12, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 1797 | MA | Primary |
Addresses
Primary practice location
190 North Main Street
Natick, MA 01760
Mailing address
190 North Main Street
Natick, MA 01760
Phone (508) 651-2646
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| Y36275 | Other | MA | BCBS |
| Y39303 | Other | MA | GROUP # BCBS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040604000826 | MA | Practitioner - Chiropractic | 4284616905 | Practice locations: Natick, MA |
Care Compare profile
Medicare Care Compare- Specialty
- Chiropractic
- Education
- Los Angeles College of Chiropractic, 1992
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
190 N Main St
Natick, MA 01760-2057
190 N Main St
Natick Sports Chiro
Natick, MA 01760-2051
Phone (508) 651-2646
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1797 | MA | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165881600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1634688000000",
"number": "1104986793",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "190 NORTH MAIN STREET",
"city": "NATICK",
"state": "MA",
"postal_code": "01760",
"telephone_number": "508-651-2646",
"fax_number": "508-655-6650"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "190 NORTH MAIN STREET",
"city": "NATICK",
"state": "MA",
"postal_code": "01760",
"telephone_number": "508-651-2646",
"fax_number": "508-655-6650"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "KELLY",
"middle_name": "A",
"credential": "DC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-12-12",
"last_updated": "2021-10-20",
"certification_date": "2021-10-20",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "MA",
"license": "1797",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "Y36275",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GROUP # BCBS",
"identifier": "Y39303",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Natick, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.